Snowmobile Club
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Print this page, fill out and mail to: Harrison Friendly Riders PO Box 817 Harrison, ME 04040 www.HarrisonFriendlyRiders.net |
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HFRSC
Membership
Includes MSA Membership Single $25.00 Family $30.00 Club Membership includes one life ins. policy |
Membership (S)
or (F): $________________ Additional Donation: ___________________ Family Members Insurance: ______________ Total Enclosed: $_______________________ |
Please fill in the following information
Name: _______________________________________________________________________
Address: _____________________________________________________________________
City:__________________________________ State: _________ Zip: ___________________
Telephone: ______________________ Email: _______________________________________
Beneficiary for MSA Insurance: __________________________ No. of Family
Members_______
Club membership includes one life inusrance policy
Additional Dependant Life Insurance aailable for $2.00 per person for
$2000.00 of coverage
Please add family members, DOB & Beneficiary for insurance below.
If additional space is needed use back of form.
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________
Name: ______________________________________ DOB: _________________